Drug rehabilitation centres in Egypt: Struggling to get clean

Dr Ahmed Dawoud estimates that only two out of ten drug addicts receive proper treatment in public drug addiction treatment centres(AFP Photo)

Despite the growing number of drug addicts in Egypt, recent reports confirm that the number of those seeking treatment for addiction is also on the rise. According to a report issued by the Fund for Drug Control and Addiction, the country’s official drug addiction body, 19,700 addicts had finalized completed treatment at its medical centres in the first six months of 2012, compared to only 18,000 in 2011. For many abusers and their families, drug rehabilitation centres are often the first place they turn in search of a way out. However, many rehab centres in Egypt suffer from illegality, unqualified management and lack of governmental supervision.

In February, controversy sparked around private rehabilitation centres in Egypt when two staff members at a private rehab institution in the neighbourhood of Moqattam were accused of torturing a drug addict until death during his therapy. The accused claimed that the deceased committed suicide, but investigations revealed that he had died from injuries resulting from excessive beatings. Since this incident, many started to question the illegal aspects of drug rehabilitation centres in Egypt.

Neglect plagues public rehabilitation centres

Am Atef joins addicts in their rooms at the rehab centre(Photo by Ethar Shalaby)

Dr. Ahmed Dawoud, a psychiatrist and a specialist in drug rehabilitation, explains that there is a wide range of rehabilitation centres in Egypt, divided into those which are publicly and privately-owned. The two largest of the public variety are Al-Abbasiya Psychiatric Hospital and Heliopolis Psychiatric Hospital, or, as the latter is commonly known, “the Airport Hospital”. Although public hospitals may suffer from illegalities, the lack of proper documentation often leads much of it to go unreported. Further, they generally suffer from an insufficient number of qualified staff and rooms to cater to the large number of addicts they receive. “Usually staff members in such institutions do not try their best with the patients, who then decide to give up the treatment and leave the hospital,” Dawoud says. He explains that the kind of care provided is far less significant than that offered in privately owned facilities. “If a drug addict does not respond to treatment or is found out to be taking drugs again in the hospital, it is likely that nobody will convince him to continue with his treatment. There is a great deal of neglect there,” he says. Only two out of every ten drug addicts receive proper treatment in public drug addiction treatment centres, estimates Dawoud.

The fund’s hotline (16023), which is dedicated to receiving calls from addicts and their families to help them with admission into public hospitals, is neither realistic nor helpful, Dawoud believes. He says that when abusers or their family members call in asking for help, the call centre usually holds the patient on a long waiting list and requires that the he or she refrain from taking in any substance for two weeks, all while remaining at home without prior treatment. “Of course this is not a practical solution for addicts. Nobody will succeed in giving up drugs for two weeks before heading to the governmental rehab centre to continue treatment. Many have to fake their urine tests, by secretly adding vinegar drops to the sample or bringing in other’s urine samples in order to deceive the hospital,” he says.

Ibrahim, a Tramadol addict who had tried to receive treatment in a public hospital, says he has failed several times to complete the programme. A microbus driver by occupation, Ibrahim had been at the hospital for a month after his mother forcefully took him there. “At the start I felt bad, [but] then I started to change my mind and insist on giving up the pills… [However] I often felt the compulsive urge [for a fix],” he says. Besides unqualified staff and lack of proper care, there are also allegations of corruption in these public centres. “They treated us well, but I know some staff members who used to take money from me and bring me pills to my room,” he says. In Al-Abbasiya Hospital, officials refused to comment on the subject.

Meanwhile, the therapy regimen implemented in public hospitals, called the No-Setback programme, has generally met with failure. “They keep the patient for three months in the hospital doing nothing but meeting with his psychiatrist in a very sporadic pattern,” Dawoud says. “The patient doesn’t really receive proper treatment from public hospitals.” The average cost of receiving treatment in any of the public rehabilitation centres ranges from EGP 1,000 to EGP 1,500 a month.

In 2009, the new charter of the Egyptian Psychology Act granted more rights for drug addicts. According to the law, no one may force a drug abuser into a treatment centre without his or her consent. “If a mother wants to send her son to a drug rehabilitation centre, she has to file a police report against him claiming that he has caused her physical harm and thus needs to be put in a rehab centre,” Dawoud explains. Before this law, a parent could call a hospital and ask the staff to pick up the addict at home for transfer. “Although this law recognises the rights of drug addicts, it has actually increased the incidence of addiction, since treatment options cannot be forced,” he says, adding that, according to the law, even once admitted, the hospital’s administration cannot oblige an addict to continue his or her treatment if he or she decides to leave.

Outside of the public option lie the private treatment centres which have become widespread across the country. Certain other rehabilitation centres are owned by well-known psychiatrists and usually provide expensive treatment for up to EGP 20,000 a month. Centres of this type rarely face problems relating to lack of qualified staff or illegality, but such high costs limit the opportunity for impoverished drug addicts to receive treatment. Dawoud, who works in Al-Tareeq Hospital for Substance Abuse Treatment, explains that there are some rehabilitation centres that lie in the middle. “Some centres, which I consider suitable for addicts from the middle class, charge between EGP 5,000 to EGP 10,000,” he says.

Ex-addicts running chaotic rehab centres

As for dilemmas endemic to the establishment of private rehabilitation centres in Egypt, Dawoud believes that the main problem lies in the poor qualifications of those running them. “There is a trend on the rise that ex-addicts who have been through the therapy before find it easy to start up their own business of rehabilitation centres,” he says. This represents a major problem, since most of them lack the scientific knowledge and the training in the proper approach to drug addiction therapy. “It starts when a drug addict forms a large base of contacts with other fellow drug addicts, having met in a rehab centre, for example. When the addicts gets out, he thinks that he knows all about the job and then starts to open his business with the wide network of drug dealers, addicts and their families,” he says.

One ex-drug addict, who owns his private rehab centre and spoke to us on condition of anonymity, says he does not think there is any difference between a professional psychiatrist running the centre or an ex-addict. “Ex-addicts are the best to understand and sympathise with the psyche of the abuser. They have been in his place before, so probably will run the business better,” he says. Explaining how he opened his small rehab centre, the owner says he did not have difficulty obtaining a licence from the Ministry of Health; all he had to do was ensure a set contacts inside the ministry who could facilitate the process. Dawoud explains that since manipulation is a basic element of addictive behaviour, ex-addicts find it easy to tinker with procedures and find a way to obtain an official license.

Dawoud says that there are dozens of stories similar to this. “Yes. It is true that an ex-addict is the best to understand an addict’s needs. But he is not the best to cure him, and herein lies the mix-up,” he explains. Rehabilitation centres in Egypt seem to represent a blind-spot for both the government and wider society. The internationally recognized 12-step programme for drug addiction treatment, which includes a set of 12 guidelines that outlines the course of recovery from substance addiction, is not properly implemented in Egypt. A correct drug addiction treatment team should be composed of a psychiatrist, a counsellor, a social worker and the patient. However, Dawoud points out that “this group is rarely formed while dealing with drug abusers in Egypt”.

Explaining the proper treatment stages from drug addiction, the psychiatrist explains that the patient first goes through a detoxification phase. “We call this phase ‘detox’, and it usually takes between a week to ten days according to the severity of the case. This is the hardest part of the entire treatment process, due to the pain the abuser feels from withdrawal symptoms,” he says. In the detox phase, a drug abuser is usually admitted to a hospital specialised for drug addiction treatment and receives medication to help absorb and extract the substance from his or her blood. “After we complete this detox phase, we move on to the rehabilitation phase, which is usually a lighter level of treatment,” Dawoud says. He adds that hashish is the only substance that remains in the blood for 40 days, so doctors transfer hashish addicts to rehabilitation centres before this period. “We do not wait for hash to come out, [and] send the abuser to rehab 10 days after the detox phase,” he explains.

As he tours a rehabilitation centre in the Giza neighbourhood of Hadayeq Al-Ahram, Dawoud explains how rehab centres work. A patient is forced to adhere to a pre-set therapy programme designed for him or her in the centre, he says, with most therapies relating to drug addiction carried out in a group format. Dawoud says this style is used in consideration of the fact that addiction is a behavioural disorder. The success of this part of the programme largely hinges on how effectively staff members help addicts change their perception of pleasure from addictive substances.

A large billiards table is placed at the reception of the rehab centre. Dawoud points out that part of their programme is to play games, practice sports and engage in honest discussions about their perception of life. “They are always in groups joined by a psychiatrist’s assistant, who is an ex-addict,” he says.

Am Atef, a man in his early fifties, describes how he spends the day with the addicts going through treatment. “I accompany three addicts in their room,” he says, “sleeping in a bed beside them, joining their conversations, and monitoring their attitudes – especially after they come back from their vacation.”

Atef, who was treated from drug addiction 13 years ago, says he knows all the manipulative means that addicts often employ to get a fix of their chosen substance. “The joy of addiction exceeds any pleasure that comes out of sex, food or drink. When I look at their eyes, I can sense who has played around and [gotten a fix], and who has taken another drug to replace his need for the substance he usually gets,” he says. Tramadol and cannabis are said to be the most widely used drugs in Egypt. At the end of every day, all drug addicts receiving treatment sit in what they call a “reflections meeting” to let out everything they did throughout the day. If any among them admit to making a mistake, they are not punished for their honesty.

The programme in the rehabilitation centre takes between four to six months, says Dawoud. However, in the psychiatry field, drug rehabilitation centres are only called “half-ways”. “There is another course of follow-up with addicts after they complete their treatments in the centre,” he explains. Part of following up with addicts after they depart the centres is keeping in constant contact with them to avoid relapses. Inside the centre, addicts not only work to cure substance addiction, but also to create a “new and clean” group of friends with whom they can keep constantly connected. “It is necessary for all drug addicts to cut all ties with drug dealers or any other abusers after they leave the centre, in order to ensure their continuing treatment,” he says, adding that the centre allows ex-addicts to return to the centre any time to spend time with others should they ever feel the urge to relapse.

The number of drug addicts who find their way to treatment inside rehabilitation centres is on the rise, but still more attention is required to move ahead with the level of drug addiction treatment in Egypt, says Dawoud.